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Author
Topic: Good News and Bad News (Read 3468 times)

Hello Family I went to the doctor yesterday to get the biopsy d/t my abnormal pap smear. I was on the table, the nurse had all the instruments and assorted little bottles and jars all lined up, I was looking up at the cealing trying to think about "some beach, some where" ( those of you who are Kenny Chesney fans will understand ) The doc moved into position, started sticking cold metal things into my most private spots, moved a microscope into place, swabbed my insides with some cool yellow stuff that he promised would turn all the bad stuff irridescent and then, stood up, told me I could get up and get dressed and he'd be back. I looked at the nurse, she looked at me and shrugged and out he went. Of course my immediate thought was " Oh no! Its so bad he cant do anything and hes going to send me to the hospital right now!" I dressed and waited, he finally came back in with a big smile on his face and says to me, " It looks very good to me! " Being the woman I am I replied, " Well Thanks Doc! " He turned a bright shade of red and proceeded to tell me there was no day glow areas in my inner regions. He decided that, considering I am approaching the dreaded menopause, that that is the culprit, gave me a RX for hormone replacement therapy and told me he'd see me in six months. So, sorry guys you had to wade through all that girly stuff, but I'm FINE!!!

Well I'm fine in THAT dept. anyway. I also went to the ID doc yesterday. I was anxious to hear how my numbers were of course. I've been worried because the counts aren't moving like they should. In April my CD4 was 306, from the original 90 last Sept. In July they were down to 206. THe VL started at a million or so last Sept and quickly went to 75,000. They were at 55,500 in April, the doc and I were not happy about that but at least they were SLOWLY moving downward. This time they were at 69,000. and the genotype showed I was beginning to be resistant to the Combivir and Viramune. I also had a horrible reaction to Sustiva when I started that last fall. So now she has started me on Viread, Reyataz and Norvir. Shes concerned that I became resistant so quickly, in about 9 months. I also have had this pain in my right side that just will not go away! Shes done blood and ultrasound tests and my liver is normal, but somethings going on in there! I dont have my gall bladder so its not that either. I'm having a CT Scan tomorrow... Thanks everyone for all your concern and warm thoughts. I love you all!

Jena, I know how you feel about the Dr. doing those test, i just hate them but like you i had nothing glowing either, just hitting 50 and i guess that change. I don't mind the change, no hot flashes yet. I hope everything goes ok tomorrow with the CTscan. I will keep you in my prayers.Please let us know how things turn out.

Jena, I am greatful that the plumbing is in good working order ! Jeezzz.. You do all this in a day!?!?!?! I for one am sorta glad I am a guy tho some would wonder??? I know your feelings about what is going on w/the bug... Let the docs find the right med combo that will keep you moving in the best possible direction. Me and Will are thinking about you honey...

Hello Jena, it is Eldon. It is good to hear that your pap smear went very well and there are no problems. I'm wishing you the best on your Cat Scan tomorrow. Please keep us posted on how things turned out.

Is there another medication missing on the new list? Norvir is usually used just as a booster to the Reyataz in this combo and is not considered an active drug. Also, do you know if you are resistant to both the Viramune and AZT/3TC in Combivir? It's very important that your next combo is potent enough to drive the viral load down to undetectable since you are now dealing with some resistance issues.

I do have to agree with Gerry, however. If you're beginning to develop resistance to Combivir, that usually means you're resistant to 3tc, which has the same resistance profile as FTC (a component in Truvada). I would consider doing what she suggested, but also add Ziagen. Or Reyetaz, Norvir + Trizivir.

Perhaps Newt has an idea for what could be combined to make a potent 3 drug combo?

Gerry is (as ever) spot on when he asks is there a drug missing here. You should be on another drug besides Reyataz, Norvir and Viread.

It is hard to say anything conclusive without knowing which mutations are causing the resistance, and to which drug, but I have these observations...

Resistance to Viramune kinda happens quickly and is usually all or nothing.

Personally right now, at least to start, I would be reaching for Kaletra, because it seems a bit stronger and more durable than Reyataz, but Reyataz is a goodie, and may just do the trick (+ 1 other drug of course).

I would put money on you being resistant now to 3TC, specifically having the M184V mutation. This is the nuke mutation that emerges quickest on people taking 3TC (one of the drugs in Combivir) who do not get a fully suppressed viral load. M184V is not necessarily a bad thing. Viread is extra good at beating this type of virus into the ground, which means that Viread+3TC (or FTC) may still work for you. Indeed, staying on the Combivir may also be viable if M184V is the only important nuke mutation you have, because AZT (the other drug in Combivir) is also extra good against this strain of virus. However, I expect this isn't the case. There are a number of other possible scenarios. Which nuke mutation? is a key question, because you need a strong combo right now, and a double PI may be better if your nuke resistance picture is difficult. Certainly Viread on its own is not going to be good enough.

How you became resistant so quickly? It is possible you started off with an undetected resistant strain in your HIV mix. But 6 months of unsuppressed viral replication is enough time for resistant-causing mutations to emerge. Your viral load has basically been level for nearly a year (if I read the dates correctly), and IMHO your doc is in error to have let this run on for so long without stepping up the treatment.

It would be helpful, if you have it, if you post the info from your genotype. Then some of the many people who know about these things here can offer you a more informed view.

Thank You all for your responses, especially Gerry and Matt! I made a copy of your comments and I am taking it to my doctors office this afternoon when I go to get my CT Scan! I appreciate you taking the time to give me this invaluable advice. Thank God for this forum and Thank God for you all!Jena